SHANE MATTHEW BJORNBERG (NPI# 1346302817) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346302817 |
| Entity Type | Individual |
| Full Name | SHANE MATTHEW BJORNBERG |
| Credential | PT |
| Practice Address |
11049 N 147th East Ave Owasso OK 74055-6263 |
| Practice Telephone | 9189786274 |
| Mailing Telephone | 9189786274 |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2013-03-28 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 225100000X | Physical Therapist | 3967 | OK | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Y | 2251X0800X |
Physical Therapist Specialization: Orthopedic |
PT 3550 | AR | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 200034500D | 05 | |
| OK | 200034500A | 05 | |
| OK | 200034500G | 05 | |
| OK | AETNA | 7784889 | 01 |
| OK | 200034500E | 05 | |
| OK | 200100580A | 05 | |
| OK | 200034500H | 05 | |
| OK | 200034500B | 05 | |
| OK | 200034500C | 05 | |
| OK | 200034500F | 05 | |
| OK | 200034500I | 05 | |
| OK | CIGNA | 6935423 | 01 |
| Street Address |
11049 N 147TH EAST AVE |
| City | OWASSO |
| State | OK |
| Zip Code | 74055-6263 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972151587 | Lakecrest Dental-owasso 96th | Dentist | 9551 N. Owasso Expressway, Suite #100, Owasso, OK 74055 | 2019-08-27 |
| 1205328697 | Eddie Duane Gaut | Case Manager/Care Coordinator | 110 W 3rd St., Apt 11, Owasso, OK 74055 | 2018-06-01 |
| 1821586694 | Kaitlyn Konarik | Speech-Language Pathologist | 12899 E 76th St N, Ste. 109, Owasso, OH 74055 | 2018-04-27 |
| 1043733769 | Kelsey Renae Nicklas | Case Manager/Care Coordinator | 9310 N 163rd East Ave, Owasso, OK 74055 | 2017-07-25 |
| 1700259256 | Genscripts Owasso, LLC | Pharmacy | 9538 N Garnett Rd, Suite 102, Owasso, OK 74055 | 2015-11-05 |
| 1770968810 | Premier Anesthesia Management Inc | Clinic/Center | 19236 E Twin Creeks Dr, Owasso, OK 74055 | 2015-07-29 |
| 1598152407 | Justin Lum | Physical Therapist | 12326 E 86th St N, Owasso, OK 74055 | 2015-04-17 |
| 1033507660 | Kimberly Louise Howard | Physical Therapy Assistant | 12899 East 76th St North, Owasso, OK 74055 | 2015-01-06 |
| 1780920629 | Timothy Ryan Thornton | Behavioral Analyst | 11330 N 94 E Ave, Owasso, OK 74055 | 2012-12-21 |
| 1679842785 | Kelli Marie Ellis | Counselor | 19760 E Fox Run Cir, Owasso, OK 74055 | 2011-12-19 |
| Find all providers in zip 74055 | ||||
| Taxonomy Code | 2251X0800X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Physical Therapist |
| Specialization | Orthopedic |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912510843 | Premier Physical Therapy LLC | Physical Therapist | 3333 W Hefner Rd Ste D, Oklahoma City, OK 73120-5060 | 2020-08-29 |
| 1437761590 | Dr. Whitney M. Ellsworth, Dpt, Pllc | Physical Therapist | 4185 S Harvard Ave, Suite E-1, Tulsa, OK 74135 | 2020-08-20 |
| 1457960718 | Ryoki Aoki | Physical Therapist | 2270 N Perkins Rd # 245, Stillwater, OK 74075-3078 | 2020-07-23 |
| 1952927816 | Juliana Joy Lackey | Physical Therapist | 1211 N Shartel Ave Ste 801, Oklahoma City, OK 73103-2425 | 2020-06-17 |
| 1285258202 | Rachel Christine Carroll | Physical Therapist | 1876 Utica Sq Ste 1b, Tulsa, OK 74114-1452 | 2020-06-05 |
| 1205491776 | Thrive Physio and Performance, LLC | Physical Therapist | 4201 Ne 116th St, Oklahoma City, OK 73131-4413 | 2019-05-09 |
| 1265819221 | Kailey N. Limber | Physical Therapist | 3327 Nw 50th, Oklahoma City, OK 73112 | 2015-04-29 |
| 1457784712 | Christopher Martin Ritchie | Physical Therapist | 613 Hillcrest St, Muskogee, OK 74403-8589 | 2013-08-09 |
| 1629339718 | Kathy Sue Bonar | Physical Therapist | 3500 S Boulevard Ste A1, Edmond, OK 73013-5486 | 2012-06-05 |
| 1649549056 | Mainstream Physical Therapy L.L.C. | Physical Therapist | 30352 S Vfw Rd, Stigler, OK 74462-3606 | 2011-12-14 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.